Senior Intake Coordinator

Highmark Inc. Job Posting

This job captures all inbound phone inquiries for utilization management review from providers and pharmacies. The incumbent assesses the verbal request, critically thinks through the inquirer's concerns which may require research to fulfill the call, such as verifying benefit coverage, creation of a prior authorization case in Highmark's Utilization Management system for Prior Authorization clinical review, status research, etc. Ensures all accurate information is verified and entered at the onset of the process to ensure adherence to all regulatory compliance requirements and service level agreements. This role may be required to make outbound calls, triage cases, and / or build cases if inventory levels require support.

Essential Responsibilities :

• Handle all inbound phone requests from providers or pharmacy for all inbound Prior Authorization requests. Use multiple software systems and various resource sites to determine member plans and requirements while gathering all appropriate documentation including verification of benefit eligibility. Ensure conversation highlights are captured within the system. If required, build cases in the utilization management system.
• Utilize critical thinking to ensure call is being appropriately responded to while gathering all required documentation. Appropriately evaluate call and determine if de-escalation is required.
• Ensure accuracy of data entry to prevent compliance and / or downstream process issues.
• Other duties as assigned or requested.

Education : Required :

High School Diploma / GED

Substitutions :

None

Preferred :

None

Experience : Required :

3 years of customer service experience

1 year of healthcare industry experience

Preferred :

None

Licenses and Certification :

Required :

None

Preferred :

None

Skills :

Possess good written and oral telephonic communication skills

Ability to navigate through multiple systems simultaneously

Knowledge of administrative and clerical procedures and systems such as word processing, managing files and digital fax

Ability to interact well with peers, supervisors, and customers

Problem-Solving

Knowledge of principles and processes for providing customer service. This includes customer needs assessment, meeting quality standards for services

Language (Other than English) : None

Travel Required : 0% - 25%

Physical, Mental Demands and Working Conditions :

Position Type : Office-Based

Teaches / trains others regularly : Frequently

Travel regularly from the office to various work sites or from site-to-site : Frequently

Works primarily out-of-the office selling products / services (sales employees) : Rarely

Physical work site required : Yes

Lifting : up to 10 pounds : Occasionally

Lifting : 10 to 25 pounds : Rarely

Lifting : 25 to 50 pounds : Rarely

Pay Range Minimum : $20.31

Pay Range Maximum : $29.53

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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